Staff Questionnaire Research Articles

Association between changes in the use of psychotropic drugs and behavioural and psychological symptoms of dementia over 1 year among long‐term care facility residents

Pharmacological treatments are often used in treating the behavioural and psychological symptoms of dementia (BPSD) in nursing homes, despite the fact that non-pharmacological treatments are recommended as a first-line treatment and can provide a suitable alternative. Because the course of BPSD is known to fluctuate depending on individual symptoms over time, the frequencies of drug use and BPSD, as well as their association, should be observed over a longer period. We investigated the association between the changes in psychotropic drug (PD) use and BPSD, focusing on the number of symptoms, severity, and care burden over 1 year among long-term care facility residents. A 1-year follow-up study was conducted among older residents with dementia or similar symptoms (n = 312 at baseline; n = 237 at follow-up) by using a care staff questionnaire in 10 long-term care facilities in Hokkaido, Japan. Medication use was determined based on prescription information. The brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD. Among residents followed up for 1 year, new users of PD-particularly anxiolytics and hypnotics-had a significantly increased number and severity of BPSD, compared with non-PD users. Continuing PDs was also related to increased severity over the year. Among residents with any persistent BPSD for 1 year, new use of PDs-particularly anxiolytics and hypnotics-was significantly associated with an increased care burden of BPSD, compared with the non-use of PDs. The discontinuation of PDs was significantly associated with a decreased care burden, compared with the non-use of PDs. Our study suggests that PDs, particularly anxiolytics and hypnotics, may be prescribed carefully in response to exacerbation of BPSD in terms of the number of symptoms, severity, and care burden in long-term care facilities. Continuous monitoring of PDs use and BPSD is important to effectively address BPSD.

How do staff motivation and workplace environment affect capacity of governments to adapt to climate change in developing countries?

Government ministries are increasingly mainstreaming climate change adaptation within policies and plans. However, government staff in key implementing ministries need to be empowered to ensure effective delivery of policy goals. Motivation to act on climate change, combined with the capacity to make decisions and apply resources to programmes, is crucial. Informed by theories of motivation and workplace environments from social psychology and organisational theory, this paper reports findings from a questionnaire of government staff (103 respondents) in Malawi, Tanzania and Zambia. The questionnaire was designed using self-determination theory to investigate the role of external influences, institutional structures and resources and how these, in turn, affect staff motivation and capacities to design and implement new policies and strategies. The study finds that whilst external influences and hierarchical structures are recognised, these do not have a strong direct influence on staff motivation, but they do appear to inhibit capacities to act. The results show that lack of staff and limited government-allocated budget reduce the ability of ministries to be self-determined and set their own agendas. Instead they are dependent on donor-determined projects which may be selective in the aspects of climate change adaptation plans and policies they support and even divert focus away from government priorities.

Strengthening the quality of paediatric primary care: protocol for the process evaluation of a health systems intervention in South Africa

BackgroundDespite significant reductions in mortality, preventable and treatable conditions remain the leading causes of death in children under five within South Africa. The WHO’s Integrated Management of Childhood Illness (IMCI)...

Effect of organizational citizenship behavior on family-centered care: Mediating role of multiple commitment.

Family-centered care is one the most important indicators of high-quality care. The organizational citizenship behavior and commitment can enhance the quality of healthcare. This study aimed to investigate the effect of the organizational citizenship behavior on family-centered care considering the mediating role of multiple commitment. This descriptive study was conducted on 237 nurses working in pediatric and infant units of hospitals in Tehran city, Iran. The subjects were selected using the convenience sampling method. Data collection was performed using the Organizational Citizenship Behavior Scale, Perceived Family-Centered Care Staff Questionnaire, Affective Commitment Scale, and Commitment to the Supervisor Scale. The SPSS v.22 and SEM-PLS v.2 software were used for data analysis. Results were extracted in the form of a standard model and fitted for indices pertaining to the measurement and structural models. Accordingly, the organizational citizenship behavior had a direct effect on family-centered care (β = 0.19, t = 2.39). Moreover, multiple commitment including commitment to the leader and commitment to the organization had indirect weak and moderate effects on the relationship between the organizational citizenship behavior and family-centered care, respectively. An inverse association was reported between commitment to the leader and family-centered care. Furthermore, the organizational citizenship behavior predicted family-centered care by 70% considering the mediating role of multiple commitment. Therefore, family-centered care as an indicator of high-quality care can be improved through enhancing the organizational citizenship behavior and organizational commitment among Iranian nurses working in pediatric wards.

Energy balance-related parenting and child-care practices: The importance of meso-system consistency.

BackgroundOur knowledge of the role of parental and child-care staff behavior in the development and prevention of obesity is rapidly increasing. Potential interaction between both settings in so-called meso-systems, as hypothesized by the ecological systems perspective, is however often ignored. Specifically, inconsistency between home and child-care is hypothesized to have negative effects on child outcomes.MethodsParticipants were recruited through 23 child-care centers in the Netherlands. Data regarding 161 child-parent-child-care staff triads were available. Parenting and child care practices were assessed using validated questionnaires for parents (Child Feeding Practices Questionnaire, Preschooler Physical Activity Parenting Practices instrument) and child-care staff (Child-care Food and Activity Practices Questionnaire), using similar items in both settings. Absolute difference scores between parents and child-care staff were calculated for each triad as a measure of meso-system consistency. Child outcomes were physical activity (as assessed by accelerometry), dietary intake (from the parental questionnaire), and measured BMI z-scores. Paired t-tests were used to examine consistency between practices in both settings. Linear regression analyses were used to explore the association of parenting practices, child-care practices and difference scores on the one hand, and child outcomes on the other.ResultsSignificant differences between settings were found for almost all practices, and in most cases child-care staff scores more favorable on the practices than parents. Inconsistencies were mostly associated with unhealthy dietary intake and lower physical activity levels, but not with BMI.ConclusionThe current study showed that inconsistencies in parenting and child-care practices exist, and that these inconsistencies seem to be associated with unhealthy behavior in children. The results underline the importance of studying meso-system influences on behavior in general, and children’s energy balance-related behavior specifically.

Ten years of simulation-based shoulder dystocia training- impact on obstetric outcome, clinical management, staff confidence, and the pedagogical practice - a time series study

BackgroundTo assess the impact of 10 years of simulation-based shoulder dystocia training on clinical outcomes, staff confidence, management, and to scrutinize the characteristics of the pedagogical practice of the simulation training.MethodsIn 2008, a simulation-based team-training program (PROBE) was introduced at a medium sized delivery unit in Linköping, Sweden. Data concerning maternal characteristics, management, and obstetric outcomes was compared between three groups; prePROBE (before PROBE was introduced, 2004–2007), early postPROBE (2008–2011) and late postPROBE (2012–2015). Staff responded to an electronic questionnaire, which included questions about self-confidence and perceived sense of security in acute obstetrical situations. Empirical data from the pedagogical practice was gathered through observational field notes of video-recordings of maternity care teams participating in simulation exercises and was further analyzed using collaborative video analysis.ResultsThe number of diagnosed shoulder dystocia increased from 0.9/1000 prePROBE to 1.8 and 2.5/1000 postPROBE. There were no differences in maternal characteristics between the groups. The rate of brachial plexus injuries in deliveries complicated with shoulder dystocia was 73% prePROBE compared to 17% in the late postPROBE group (p > 0.05). The dominant maneuver to solve the shoulder dystocia changed from posterior arm extraction to internal rotation of the anterior shoulder between the pre and postPROBE groups. The staff questionnaire showed how the majority of the staff (48–62%) felt more confident when handling a shoulder dystocia after PROBE training. A model of facilitating relational reflection adopted seems to provide ways of keeping the collaboration and learning in the interprofessional team clearly focused.ConclusionsTo introduce and sustain a shoulder dystocia training program for delivery staff improved clinical outcome. The impaired management and outcome of this rare, emergent and unexpectedly event might be explained by the learning effect in the debriefing model, clearly focused on the team and related to daily clinical practice.

The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

BackgroundMedication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either “generally”, “sometimes” or “exceptionally” appropriate for NH residents with severe dementia.MethodsA quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents’ families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran’s-Q tests.ResultsThe KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a “sometimes appropriate” medication post-intervention were 0.81 (95% CI: 0.71–0.92) and 0.83 (95% CI: 0.74–0.94), respectively.ConclusionA simple KE intervention using a medication review guidance tool categorizing medications as being either “generally”, “sometimes” or “exceptionally” appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.

Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study

BackgroundConcerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.ObjectivesTo assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.DesignPilot cluster randomised trial (CRT) and associated process and economic evaluations.SettingSix inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).ParticipantsPatients (n = 639), staff (n = 211) and visitors (n = 188).InterventionCLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.Main outcome measuresQuality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).Data sourcesStructured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.ResultsThe pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.LimitationsFindings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.ConclusionsUse of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.Trial registrationCurrent Controlled Trials ISRCTN16789770.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.

Structured Interdisciplinary Bedside Rounds in an Australian tertiary hospital emergency department: Patient satisfaction and staff perspectives.

To compare patient satisfaction levels, staff perspectives and the time required using Structured Interdisciplinary Bedside Rounds (SIBR; Emory University, Atlanta, GA, USA) versus traditional medical ward rounds (TR) in the ED. We conducted an observational cross-sectional study. Ward rounds were categorised into a modified SIBR and TR at a tertiary ED in Australia according to predefined criteria. We compared the duration of ward rounds, invited patients and staff to complete anonymous questionnaires to compare patient satisfaction and staff perspectives. During the study period, SIBR group took significantly longer time than TR per patient (122 vs 88 s, P < 0.001). Patient questionnaires were completed for 320 encounters (101 SIBR, 219 TR). Patient satisfaction scores across all measured domains were significantly higher in SIBR than in the TR group. Patients often pointed out a lack of communication with medical staff during TR. Based on 131 completed staff questionnaires, nurses reported SIBR to be more useful than TR (nurses 78% vs doctors 44%, P = 0.001). The SIBR group had increased instances of staff introductions to patients (91% vs 66%, P < 0.001) and patients' involvement in discussion of management plans (98% vs 53%, P < 0.01). SIBR only weakly correlated with the overall positive experience in the ED (r = 0.19, P = 0.001). Organisational implementation issues raised through qualitative methods are reported in the paper. Our study highlights the benefits that could be gained through SIBR technique over the TR method. Better workforce and resource planning is needed to support the sustainable implementation of SIBR in ED.

Incorporating an Undergraduate Student in Nursing program into the workforce: a prospective observational study

Objectives: The objective was to describe the organisational perspective of the implementation of the Undergraduate Student in Nursing (USIN) program and to describe the experience of nursing staff working with these Undergraduate Students in Nursing. Design: Prospective, observation design. Setting: The study took place at a large tertiary paediatric hospital in Brisbane, Australia over a twelve month period. Subjects: Participants were registered nurses (n=169) employed in a permanent capacity in the following clinical areas – medical, surgical, rehabilitation, paediatric intensive care unit and perioperative. Interventions: Pre and post staff questionnaires were distributed to staff based on three domains; anticipated thought; assertion in the workplace and role delineation; and reflective practice. Results: Prior to implementation of USINs, the primary concerns of staff surrounding the introduction of the role included; impact on patient safety, poor skill mix, decrease in quality of care and patient and family satisfaction, impact on unit/ward operation, and the potential attitudes of the students. At 12 months post-implementation, respondents felt that patient safety had increased, skill mix had not been adversely impacted, workload had improved, overall quality of patient care and satisfaction had increased among children and parents. Conclusion: This introduction improved important elements within the clinical space such as patient safety and quality of care. Registered nurses perceived their workload was reduced and parent and child satisfaction was increased. The results of this study could be generalised beyond paediatrics to adult facilities. We would recommend other organisations consider this model if faced with similar workforce demands.

Is this the culture of academies? Utilising the cultural web to investigate the organisational culture of an academy case study

This paper examines the organisational culture of a comprehensive school that converted to an academy in 2010 by utilising the cultural web model as a tool for analysing an academy’s culture. The case study employs a concurrent mixed-method approach of questionnaires for staff with no responsibility (SNR), focus groups for staff with management responsibility (SMR) and interviews with members of the Senior Leadership Team (SLT). The subsequent results are then discussed in relation to three themes, extracted from the cultural web – ‘student-centric’, ‘staff constraints’ and ‘leadership issues’. The findings from this research successfully demonstrate the model’s ability to afford valuable insight into an academy by offering a depiction of its organisational culture and targets for organisational improvement. In addition, the paper presents a method for the future deployment of the cultural web which enables comparisons of an academy’s subcultures.

Health care provision for refugees in Germany \u2013 one-year evaluation of an outpatient clinic in an urban emergency accommodation

BackgroundIn 2015, Germany recorded the highest rates of refugees since the early 1990s. Access to medical care is a legally regulated fundamental element of aid for refugees. In practice, there are several hurdles such as language barriers and legal regulations. In response to the massively increased need, special outpatient services for refugees were started in several German cities. In Cologne, an outpatient clinic (OPD) was established in the largest emergency accommodation centre for refugees supported by the Cologne municipality and operated by the German Red Cross and physicians from the Association of Statutory Health Insurance Physicians. This study reports experiences of the first year of the OPD regarding structure, processes and utilization.MethodsEmploying mixed methods, between May and December 2015 cross sectional pseudonymized data from patients’ contacts were collected, coded in the International Classification of Primary Care (ICPC) and evaluated. Infrastructure, equipment, process organisation and function of the OPD were assessed during five participatory observations and triangulated with results of a self-administered questionnaire for staff and four qualitative interviews with key informants.ResultsDuring the observation period a total of 2205 persons (67% male) stayed in the emergency accommodation and 984 patient contacts (51% male) were registered, mainly by young persons from Western Balkan countries and Syria. Medical treatment was sought primarily for acute respiratory-, loco-motor-system- and skin symptoms followed by chronic physical diseases. Headache, back and neck pain and acute respiratory infection were the most frequent diagnoses. Questionnaires and interviews among staff revealed language barriers and psycho-trauma as the most frequently reported challenges. Equipment and staffing was adequate, but patient documentation was not systematic, leading to loss of information.ConclusionTo facilitate refugees’ appropriate access to health care, the OPD was seen as functional for this refugee accommodation centre. Need was recognised for standardized, data protective documentation and a health passport for clients for medical information. Psychological support for refugees needs expansion taking legal circumstances and coverage of costs into consideration. To improve patient communication employees working with refugees should be offered an introduction to culturally sensitive understanding of health and illness.

Developing and feasibility testing of data collection methods for an economic evaluation of a supported selfmanagement programme for adults with a learning disability and type 2 diabetes

BackgroundThe challenges of conducting research with hard to reach vulnerable groups are particularly pertinent for people with learning disabilities. Data collection methods for previous cost and cost-effectiveness analyses of health and social care interventions targeting people with learning disabilities have relied on health care/health insurance records or data collection forms completed by the service provider rather than by people with learning disabilities themselves. This paper reports on the development and testing of data collection methods for an economic evaluation within a randomised controlled trial (RCT) for a supported self-management programme for people with mild/moderate learning disabilities and type 2 diabetes.MethodsA case finding study was conducted to identify types of health and social care use and data collection methods employed in previous studies with this population. Based on this evidence, resource use questionnaires for completion by GP staff and interviewer-administered participant questionnaires (covering a wider cost perspective and health-related quality of life) were tested within a feasibility RCT. Interviewer-administered questionnaires included the EQ-5D-3L (the NICE recommended measure for use in economic evaluation). Participants were adults > 18 years with a mild or moderate learning disability and type 2 diabetes, with mental capacity to give consent to research participation.ResultsData collection for questionnaires completed by GP staff requesting data for the last 12 months proved time intensive and difficult. Whilst 82.3% (121/147) of questionnaires were returned, up to 17% of service use items were recorded as unknown. Subsequently, a shorter recall period (4 months) led to a higher return rate but with a higher rate of missing data. Missing data for interviewer-administered participant questionnaires was > 8% but the interviewers reported difficulty with participant recall. Almost 60% (48/80) of participants had difficulty completing the EQ-5D-3L.ConclusionsFurther investigation as to how service use can be recorded is recommended. Concerns about the reliability of identifying service use data directly from participants with a learning disability due to challenges in completion, specifically around recall, remain. The degree of difficulty to complete EQ-5D-3L indicates concerns regarding the appropriateness of using this measure in its current form in research with this population.Trial registrationCurrent Controlled Trials ISRCTN41897033 (registered 21 January 2013).

E-readiness assessment of academic libraries: a case study in Iran

PurposeThe purpose of this study is to assess the e-readiness status of libraries in the Shahid Beheshti University of Medical Sciences in terms of four dimensions – human resources, electronical infrastructure, network services and programs and enhancers of the networked world.Design/methodology/approachThe study population consists of 11 libraries of the Shahid Beheshti University of Medical Sciences, including the central library and 10 faculty libraries. The data collection instrument is a questionnaire prepared by the researchers that has been designed on the basis of the “e-readiness assessment of Iranian academic libraries model”. Depending on the respondents there are three parts to the questionnaire: questionnaire for managers, staff and information and communication technology (ICT) officials. Their reliability and validity have been proved.FindingsThe libraries of Shahid Beheshti University of Medical Sciences had an average to high status in terms of “human resources” with a score of 2.32, “electronic infrastructure” with a score of 2.48, “network services and programs” with a score of 2.09 and “networked world enhancers” with a score of 2.37 out of 4. In total, these libraries had an average to high status in terms of e-readiness, with a score of 2.29.Originality/valueThe findings of this study can help the library administrators and officials of Shahid Beheshti University of Medical Sciences to plan improvements to the situation of ICT.

COMPARATIVE ANALYSIS OF THE RESULTS OF QUESTIONING OF PATIENTS AND MEDICAL PERSONNEL IN ORDER TO FORM METHODOLOGICAL ASPECTS OF CONTROL OF THE OPTIMAL ORGANIZATION OF PROCESSES IN A MEDICAL INSTITUTION

The article presents a comparative analysis of the results of questioning of patients and medical personnel using the tools of lexical analysis of medical records. The questioning was conducted simultaneously in a 24-hour in-patient clinic. A survey was conducted of all patients discharged from the hospital during the week, and all medical workers who worked during the period. The questionnaire for staff includes questions about patient satisfaction. The formulation of questions is «mirror» to the questions of the questionnaire of patients. The results of the questionnaire convincingly testify to a higher assessment of the conditions and the provision of medical care to patients compared with the assessment by medical personnel.

Exploring the differential impact of individual and organizational factors on organizational commitment of physicians and nurses

BackgroundPhysician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups.Based on recent findings in the literature and the results of a pilot study, we investigate the degree to which selected individual and organizational characteristics might enhance an employee’s affective commitment working in the field of neonatal intensive care. Moreover, our aim is to examine the different antecedent-commitment relationships across the occupational groups of nurses and physicians.MethodsInformation about individual factors affecting organizational commitment was derived from self-administered staff questionnaires, while additional information about organizational structures was taken from hospital quality reports and a self-administered survey completed by hospital department heads. Overall, 1486 nurses and 540 physicians from 66 Neonatal Intensive Care Units participated in the study. We used multilevel modeling to account for different levels of analysis.ResultsAlthough organizational characteristics can explain differences in an employee’s commitment, the differences can be largely explained by his or her individual characteristics and work experiences. Regarding occupational differences, individual support by leaders and colleagues was shown to influence organizational commitment more strongly in the physicians’ group. In contrast, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses’ organizational commitment.ConclusionsWith the growing number of hospitals facing an acute shortage of highly-skilled labor, effective strategies on the individual and organizational levels have to be considered to enhance an employee’s commitment to his or her organization. Regarding occupational differences in antecedent-commitment relationships, more specific management actions should be undertaken to correspond to different needs and aspirations of nurses and physicians.Trial registrationGerman Clinical Trials Register (DRKS00004589, date of trial registration: 15.05.2013).

An evaluation of the objective quality and perceived usefulness of maternity clinical practice guidelines at a tertiary maternity unit.

Compliance with maternity clinical practice guidelines developed by National Women's Health has been found to be low at audit. To explore the reasons for poor compliance with maternity guidelines by evaluating the quality of a sample of National Women's Health guidelines using a validated instrument and assessing local guideline users' perceptions of and attitudes toward guidelines. Five independent reviewers evaluated the quality of 10 purposively selected guidelines for adherence to the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument standards. A self-administered questionnaire for staff was undertaken regarding views of and barriers to guideline use. None of the guidelines attained a score over 50% for the following domains: stakeholder involvement, rigour of development, applicability, editorial independence. The highest scoring domain was clarity of presentation (mean 69%). All guidelines scored the minimum possible for editorial independence. Survey respondents had positive attitudes toward guidelines, believed that their use could improve quality of care within the service, and felt that encouragement from senior staff members and peers would encourage their use. Accessibility was the most commonly cited of many barriers identified. The National Women's Health guidelines evaluated in this study cannot be considered to be high quality, and could be improved by reporting on methodology of the development process. Although poor guideline development may contribute to failure of the local maternity guidelines, it appears that accessibility is a major barrier to their use and implementation.

Ethical Leadership Behaviour Of Heads Of Department And Job Performance Of Academic Staff In South-South Universities, Nigeria

The purpose of this study was to determine the relationship between ethical leadership behaviour of heads of department and job performance of academic staff in South-South Universities, Nigeria. Three null hypotheses formulated for the study were tested using the simple regression analysis at 0.05 level of significance, 1 and 998 degrees of freedom. The ex-post facto survey design was used. The study population was 739 heads of department and 14,000 academic staff in public Universities in South-South, Nigeria. The multi- stage sampling technique involving stratified sampling and simple random sampling was used to select a sample of 204 heads of department and 1020 academic staff for the study. A researcher made instruments, “Ethical Leadership Behaviour of Heads of Department Questionnaire (ELBHDQ)” and “Job Performance of Academic Staff Questionnaire (JPASQ)” with items measured on 4-point rating scale were used for data collection. The instruments were given to two validates in educational management and educational evaluation in the University of Uyo to determine the validity. The reliability of the instruments was also determined by internal consistency method using the cronbach’s alpha analysis in which coefficients of 0.76 and 0.82 showed that the instruments were reliable. All the three hypotheses were rejected since the calculated F-values of 15.19, 6692.30 and 2333.33 were greater than the critical F-value of 3.84 thus indicating that there was a significant relationship between ethical leadership behaviour of heads of department and job performance of academic staff in South-South Universities in Nigeria. It was concluded that management should maintain high ethical standards in the Universities so that the employees’ job performance would improve. Among the recommendations was that the University management should enforce disciplinary actions against unethical conduct. Indiscipline staff with clear cases of misconduct should be sanctioned or sacked.

Assessment of bedside transfusion practices at a tertiary care center: A step closer to controlling the chaos.

BACKGROUND:Blood transfusion chain can be divided into three phases: preanalytical (patient bedside), analytical (steps done at transfusion services), and postanalytical (bedside). Majority (~70%) of events due to blood transfusion have been attributed to errors in bedside blood administration practices. Survey of bedside transfusion practices (pre-analytical and post analytical phase) was done to assess awareness and compliance to guidelines regarding requisition and administration of blood components.MATERIALS AND METHODS:Interview-based questionnaire of ward staff and observational survey of actual transfusion of blood components in total 26 wards of the institute was carried out during November–December 2013. All the collected data were coded (to maintain confidentiality) and analyzed using SPSS (v 20). For analysis, wards were divided into three categories: medical, surgical, and others (including all intensive care units).RESULTS:A total of 104 (33 resident doctors and 71 nursing) staff members were interviewed and observational survey could be conducted in 25 wards during the study period. In the preanalytical phase, major issues were as follows: lack of awareness for institute guidelines (80.6% not aware), improper sampling practices (67.3%), and prescription related (56.7%). In the postanalytical phase, major issues were found to be lack of consent for blood transfusion (72%), improper warming of blood component (~80%), and problems in storage and discarding of blood units.CONCLUSION:There is need to create awareness about policies and guidelines of bed side transfusion among the ward staff. Regular audits are necessary for compliance to guidelines among clinical staff.

Feasibility, Safety, Adherence and Efficacy of High-Intensity Interval Training Cardiac Rehabilitation Programs for Patients with Coronary Heart Disease

There are reservations regarding the clinical application of high-intensity interval training (HIIT) in real-world cardiac rehabilitation settings. This study investigated HIIT compared with moderate-intensity continuous training (MICT) within a standard hospital cardiac rehabilitation program. Two hundred and sixty adults with angiographically proven coronary artery disease undergoing a standard 4-week cardiac rehabilitation program were approached. Ninety-three patients were subsequently randomised to: 1) HIIT (n = 46): 4 x 4-minute high-intensity intervals at 15–18 rating of perceived exertion (RPE, range 6–20) interspersed with 3-minute active recovery periods; or 2) MICT (n = 47): usual-care exercise involving 40-minutes of aerobic exercise at 11–13 RPE. Participants completed two supervised sessions and one home-based session per week. Feasibility was assessed using staff and participant questionnaires. The incidence and seriousness of adverse events were recorded to evaluate safety. Adherence to the exercise protocol was assessed from exercise records and self-report logs. Average training RPE was significantly higher for HIIT (16 ± 1 vs 12 ± 1) and resulted in a significant improvement in peak oxygen uptake compared to MICT (+2.9 ± 3.5 vs +1.1 ± 0.0 mL/kg/minute, p = 0.012). There was no difference in the incidence of serious adverse events between HIIT (n = 2) and MICT (n = 2). Adherence to the exercise protocol was high in both groups (HIIT 80% vs MICT 87%). Feasibility scores were equal between groups (98%) regarding desire to continue their randomised training. Staff acceptance of the HIIT program was high. Compared to usual care (MICT), HIIT was safe, feasible, and more efficacious for improving fitness without loss of exercise adherence.